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Neurology Jan 2019Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that... (Review)
Review
Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.
Topics: Diagnostic Errors; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Neurologic Examination; Oligoclonal Bands
PubMed: 30381369
DOI: 10.1212/WNL.0000000000006583 -
Developmental Medicine and Child... Oct 2008The aim of this study was to validate the expanded and revised Gross Motor Function Classification System (GMFCS-E&R) for children and youth with cerebral palsy using... (Comparative Study)
Comparative Study
The aim of this study was to validate the expanded and revised Gross Motor Function Classification System (GMFCS-E&R) for children and youth with cerebral palsy using group consensus methods. Eighteen physical therapists participated in a nominal group technique to evaluate the draft version of a 12- to 18-year age band. Subsequently, 30 health professionals from seven countries participated in a Delphi survey to evaluate the revised 12- to 18-year and 6- to 12-year age bands. Consensus was defined as agreement with a question by at least 80% of participants. After round 3 of the Delphi survey, consensus was achieved for the clarity and accuracy of the descriptions for each level and the distinctions between levels for both the 12- to 18-year and 6- to 12-year age bands. Participants also agreed that the distinction between capability and performance and the concept that environmental and personal factors influence methods of mobility were useful for classification of gross motor function. The results provide evidence of content validity of the GMFCS-E&R. The GMFCS-E&R has utility for communication, clinical decision making, databases, registries, and clinical research.
Topics: Activities of Daily Living; Adolescent; Cerebral Palsy; Child; Delphi Technique; Disability Evaluation; Disabled Children; Health Status Indicators; Humans; Motor Skills; Motor Skills Disorders; Neurologic Examination
PubMed: 18834387
DOI: 10.1111/j.1469-8749.2008.03089.x -
Journal of Neurology, Neurosurgery, and... Jul 1990Two short tests of motor function, the Motricity Index (MI) and the Trunk Control Test (TCT), were assessed at regular intervals after stroke and compared with a...
Two short tests of motor function, the Motricity Index (MI) and the Trunk Control Test (TCT), were assessed at regular intervals after stroke and compared with a detailed physiotherapy test, the Rivermead Motor Assessment (RMA). The MI and TCT were valid and reliable tests which were usually quicker to perform than the RMA. The TCT was of predictive value when related to eventual walking ability. All three tests appeared to be of equal sensitivity in detecting change.
Topics: Adolescent; Adult; Aged; Cerebrovascular Disorders; Disability Evaluation; Female; Follow-Up Studies; Hemiplegia; Humans; Male; Middle Aged; Neurologic Examination
PubMed: 2391521
DOI: 10.1136/jnnp.53.7.576 -
Journal of Clinical Neuroscience :... Apr 2023Following acute brain injury, frequent neurological examinations ("neurochecks") are commonly prescribed and form the cornerstone of many care protocols and guidelines...
Following acute brain injury, frequent neurological examinations ("neurochecks") are commonly prescribed and form the cornerstone of many care protocols and guidelines (e.g., for intracranial hemorrhage). While these assessments are intended to identify and mitigate secondary injury, they may unintentionally contribute to additional injury related to neurocheck-associated sleep disruption. Data are lacking to define patterns of neurological decline following acute brain injury, as are data to define the short- and long-term consequences (e.g., neuropsychological sequelae) of frequent and prolonged neurochecks. A critical need exists for rigorous evaluation of neurocheck practices, perceptions, benefits and risks, along with interventions to optimize neurocheck frequency and duration.
Topics: Humans; Brain Injuries; Neurologic Examination; Intracranial Hemorrhages; Disease Progression; Critical Care
PubMed: 36822072
DOI: 10.1016/j.jocn.2023.02.009 -
American Family Physician Mar 2018Dementia is a significant and costly health condition that affects 5 million adults and is the fifth leading cause of death among Americans older than 65 years. The... (Review)
Review
Dementia is a significant and costly health condition that affects 5 million adults and is the fifth leading cause of death among Americans older than 65 years. The prevalence of dementia will likely increase in the future because the number of Americans older than 65 years is expected to double by 2060. Risk factors for dementia include age; family history of dementia; personal history of cardiovascular disease, cerebrovascular disease, diabetes mellitus, or midlife obesity; use of anticholinergic medications; apolipoprotein E4 genotype; and lower education level. The U.S. Preventive Services Task Force and the American Academy of Family Physicians have concluded that current evidence is insufficient to assess the benefits vs. harms of screening for cognitive impairment in older adults. If dementia is suspected, physicians can use brief screening tests such as Mini-Cog or General Practitioner Assessment of Cognition. If the results are abnormal, further evaluation is warranted using more in-depth screening tools such as the Montreal Cognitive Assessment, Saint Louis University Mental Status Examination, or Mini-Mental State Examination. Diagnostic testing and secondary evaluation, including screening for depression, appropriate laboratory studies for other conditions that cause cognitive impairment, and magnetic resonance imaging of the brain, should be performed when cognitive impairment is confirmed. Routine cerebrospinal fluid testing and genetic testing for the apolipoprotein E4 allele are not recommended.
Topics: Cognition; Dementia; Humans; Mass Screening; Neurologic Examination; Neuropsychological Tests
PubMed: 29671539
DOI: No ID Found -
Anesthesiology Mar 2019Anesthetics have profound effects on the brain and central nervous system. Vital signs, along with the electroencephalogram and electroencephalogram-based indices, are... (Review)
Review
Anesthetics have profound effects on the brain and central nervous system. Vital signs, along with the electroencephalogram and electroencephalogram-based indices, are commonly used to assess the brain states of patients receiving general anesthesia and sedation. Important information about the patient's arousal state during general anesthesia can also be obtained through use of the neurologic examination. This article reviews the main components of the neurologic examination focusing primarily on the brainstem examination. It details the components of the brainstem examination that are most relevant for patient management during induction, maintenance, and emergence from general anesthesia. The examination is easy to apply and provides important complementary information about the patient's arousal level that cannot be discerned from vital signs and electroencephalogram measures.
Topics: Airway Extubation; Anesthesiologists; Anesthetics, Inhalation; Arousal; Electroencephalography; Humans; Neurologic Examination; Postoperative Care
PubMed: 30664547
DOI: 10.1097/ALN.0000000000002559 -
Sports Health 2016With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical... (Review)
Review
CONTEXT
With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination.
EVIDENCE ACQUISITION
Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 3.
RESULTS
The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties.
CONCLUSION
Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.
Topics: Athletic Injuries; Brain Concussion; Diagnosis, Differential; Humans; Musculoskeletal System; Neurologic Examination; Physical Examination; Postural Balance; Psychomotor Performance; Vestibule, Labyrinth; Vision Disorders
PubMed: 27022058
DOI: 10.1177/1941738116641394 -
The Canadian Journal of Neurological... Sep 2020To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and... (Review)
Review
OBJECTIVE
To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond.
METHODS
The full neurologic examination is described with attention to components that can be performed virtually.
RESULTS
A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations).
CONCLUSIONS
During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Neurologic Examination; Neurologists; Pandemics; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2; Telemedicine; Video Recording
PubMed: 32434626
DOI: 10.1017/cjn.2020.96 -
Arquivos de Neuro-psiquiatria Feb 2015The objective of this article is to highlight some of the most important pioneering books specifically focused on the neurological examination and their authors. During... (Review)
Review
The objective of this article is to highlight some of the most important pioneering books specifically focused on the neurological examination and their authors. During the XIX Century, Alexander Hammond, William Gowers and Charles Mills pioneered the neurological literature, followed in the XX Century by Aloysio de Castro, Monrad-Krohn, Derek Denny-Brown, Robert Wartenberg, Gordon Holmes, and Russel DeJong. With determination and a marked sense of observation and research, they competently developed and spread the technique and art of the neurological exam.
Topics: History, 19th Century; History, 20th Century; Humans; Nervous System Diseases; Neurologic Examination; Neurology; Textbooks as Topic
PubMed: 25742584
DOI: 10.1590/0004-282X20140215 -
Journal of the American Veterinary... May 2021To describe a modified approach to neurologic examination of African pygmy hedgehogs ().
OBJECTIVE
To describe a modified approach to neurologic examination of African pygmy hedgehogs ().
ANIMALS
12 adult hedgehogs (7 males and 5 females).
PROCEDURES
Aspects of the standard neurologic examination of dogs and cats were evaluated for use with awake hedgehogs, and modified approaches to evaluating their normal behavior and mentation, select cranial nerves and refexes, and gait were then identified. Behavioral analysis and gait analysis were performed by using video recordings of hedgehogs in a novel environment. Performability and repeatability of all feasible aspects of the neurologic examination were assessed.
RESULTS
Most aspects of the standard neurologic examination could be successfully performed, with repeatable results. However, certain aspects, especially those evaluating the pelvic limbs, were more difficult to perform successfully or were less repeatable. All hedgehogs lacked a menace response but displayed a contraction of the frontodorsalis muscle. Facial sensation testing was unreliable.
CONCLUSIONS AND CLINICAL RELEVANCE
The entire standard neurologic examination could not be performed in hedgehogs. However, many aspects could be performed, and together they provided baseline data for neurologic examination of this species.
Topics: Animals; Female; Hedgehogs; Male; Neurologic Examination
PubMed: 33856861
DOI: 10.2460/javma.258.9.971